Individual
GINA PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2017 W I 35 FRONTAGE RD STE 250, EDMOND, OK 73013-8561
(405) 757-3340
(405) 757-3520
Mailing address
2017 W I 35 FRONTAGE RD STE 250, EDMOND, OK 73013-8561
(405) 757-3340
(405) 757-3520
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
42869
OK
207X00000X
Orthopaedic Surgery Physician
MD481359
PA
Other
Enumeration date
06/20/2018
Last updated
08/29/2024
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